I am an RN. I manage a unit and LPNs do the floor work. They are subordinate to me, in licensure and hierarchy. I do NOT play that up.
This morning, a "floating" nurse had the 6 a.m. medication pass and missed meds for 4 patients. Most were not critical, one was a huge dose of insulin for a diabetic whose blood sugar has been out of control.
The LPN notices the meds were missed. They are now 1 1/2 hours out of range for compliance with being given at the right time. The night nurse was still in the building so I verified with her that she had NOT given the meds. I told the current nurse to give them. She said nothing.
At 1130 she tells me that the patient who gets the insulin has a blood sugar of 463. I asked, "Even after the 36 units of Lantus?" She says, "I didn't give any Lantus. It was out of the time range." "Did you give everyone else their meds?" "No, I can't. They're late." Now, "nursing judgment" is the prerogative of every nurse, but the supervising RN supersedes the LPN. I've been an LPN and know how frustrating that is, but LPNs work under the direct supervision of RNs. And I am responsible for what happens when I am the supervising RN.
At this point I have to call the doctor AND write up the night nurse for med errors. What should have been simple is now a big hairy time-consuming deal. Of course, he tells me to give all the meds as none are that time-sensitive and need to be given.
I note all the charts and tell her to give the meds.
And I write her up.
All hell breaks loose. Even the aides are yelling about how unfair it is that A made an error and B is getting written up. I leave the unit for 20 minutes to compose myself. Meanwhile, I have a resident running two separate IV antibiotics and have administrative tasks to perform and am now behind because I spent an hour writing up errors, calling doctors, and writing up people. None of which whould have been necessary had she not just been defiant.
2 pm comes and I notice that she hasn't given the meds. I start passing them. She actually says, "Are you giving those 5 am meds?" "Yes." "You need to write orders for them all." "Um, no, the system will mark them at the time they were given." "Yeah, but no one will know they were late unless you write a note." "You think I didn't write progress notes two hours ago when I gave you the instructions to give them?"
WTH?! HOLDING 36 UNITS OF INSULIN? THAT'S NURSING JUDGMENT BY HER? And holding glyburide on someone else, who gets only that all day for her BS?
This is the difference between an RN with critical thinking skills, and an LPN who just "does' or doesn't," without any thought as to what the ramifications are. I cringe when I hear about hospitals who continue to allow LPNs work in the ICU, or ER. JMHO and my NY $0.02.
LIndarn, RN, BSN, CCRN
Well, I have to say, Linda, that I disagree that critical thinking skills are the exclusive domain of the RN. I have worked and do work with some excellent LPNs who are always eager to learn and expand their knowledge. Hell, some of my CNAs are sritical thinkers. She is, fortunately, the exception rather than the rule.
I agree with Sue that this person's job behavior is not the result of her being an LPN, but of her negative attitude toward anyone who is higher than her on the totem pole. If she were the DON of the facility, she probably would demonstrate a negative attitude toward her supervisor, the administrator.
Specializes in Peds/outpatient FP,derm,allergy/private duty.
This is the difference between an RN with critical thinking skills, and an LPN who just "does' or doesn't," without any thought as to what the ramifications are. I cringe when I hear about hospitals who continue to allow LPNs work in the ICU, or ER. JMHO and my NY $0.02.
LIndarn, RN, BSN, CCRN
I'm sure you probably didn't intend this, but these comments often provoke a blizzard of indignant responses and bury the original topic. I think Sue's topic is a good one and I'd hate to see that happen.
I'm sure you probably didn't intend this, but these comments often provoke a blizzard of indignant responses and bury the original topic. I think Sue's topic is a good one and I'd hate to see that happen.
ITA..besides, this has nothing to do with critical thinking and all to do with a dangeous and selfish nurse that should not be working in the field.
Specializes in trauma, ortho, burns, plastic surgery.
I try to not be on the evil side and I will do it, because sometime WE think just looking at OUR own position, without making conexions with others and REALITY!.
This history is a TYPICAL nursing case of passing liability, passing accountability!
Who discover the missing meds doses? THAT person is accountable about everythink that was happend after.
WHO discoverd the med error/missing, huh? Is her accountability!
THAT PERSON needed to announce FIRST THE DOCTOR! Special with a FS high!
Is her discovery she need IN PERSON to contact the doctor!
Lantus given even with 1 hour and half late was not the best care judgemment for a high FS.
Doctor needed to know THEN and take the measures RIGHT THE WAY!
2. If someone else announced the doctor, needs to write the nurses note and to specify in then...."endoresed to LPN nurse Lola the doctor decision, to give meds from 5 am now at 7.30 am" .
Sue your LPN, tried to take off the charcol from fire with your hands and pass the accountability on YOU. Is happen often!
Verba volant scripta manet..... when you told her to give meds, you needed to write a nursing note about.... and to tell her.... "You have a note in nursing notes and a new order approved by doctor to give missing meds NOW, so please give it NOW", and let her away.... after that you go back and verify her, plus if she writes the notes about.
If not.... bad choice!
ALL of us we need to be accountable for OUR OWN decisions or mistakes, not to pass acountability to another one...
Next time...let her to call the doctor and verify!
If you are smart prove that you are!
IS NOT AT ALL ABOUT AUTHORITY! Why remember me about military...OMG!
Is about good nurses and others.......if you are a good one prove it, take the good decisions or admit when others had a much better ideas than you or you did a bad one, and NOT pass the accountability...
Sue it sounds like you had the shift from hell, so hugs to you. It sounds like this nurse has a real history of problems...time for her to hit the road.
This is the difference between an RN with critical thinking skills, and an LPN who just "does' or doesn't," without any thought as to what the ramifications are. I cringe when I hear about hospitals who continue to allow LPNs work in the ICU, or ER. JMHO and my NY $0.02.
LIndarn, RN, BSN, CCRN
Tut tut...sue, honey not to hijack your thread:) But I've just gotta say it.
As a LPN who currently works ICU, AND who's currently enrolled in a LPN-RN bridge, I deeply resent this comment. I have worked with MANY an incompetent RN in my time, that have made some stupid stupid mistakes.
I I totally agree with zuzi. Sue, I know I'm just a new grad but I really think the lpn should have been the one whom call the doc, get the new orders, document, write the incident rpt. and etc. She should have listened to you however she is working on her Own license and will be held responsible. I'm sorry this all happened. Take care.
I tried to ignore you Lindarn, but, I can't. I don't care how many initials are after your name, who do you think you are? I didn't need anyone to tell me what to do in that situation, because I knew what to do because of my experience. Who do you think you are putting me and alot of skilled, critical thinking, LPN's down? I think you owe ALL of us an apology. Thank you Sue for the compliment I love working with RN's who appreciate my 30 years of experience.
I tried to ignore you Lindarn, but, I can't. I don't care how many initials are after your name, who do you think you are? I didn't need anyone to tell me what to do in that situation, because I knew what to do because of my experience. Who do you think you are putting me and alot of skilled, critical thinking, LPN's down? I think you owe ALL of us an apology. Thank you Sue for the compliment I love working with RN's who appreciate my 30 years of experience.
I'm so proud of myself that I ignored lindarn comment but I do admit that after reading that comment it felt like a knife went through my heart. It does hurt...
Thank you Sue for the compliment I love working with RN's who appreciate my 30 years of experience.
SuesquatchRN, BSN, RN
10,263 Posts
Well, I have to say, Linda, that I disagree that critical thinking skills are the exclusive domain of the RN. I have worked and do work with some excellent LPNs who are always eager to learn and expand their knowledge. Hell, some of my CNAs are sritical thinkers. She is, fortunately, the exception rather than the rule.